The Obamacare 'fix' is in: Now, where do we go from here?

Maggie Fox

Friday, 15 Nov 2013 | 10:38 AM ETNBC News

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An insurance agent helps a woman navigate insurance options.

President Barack Obama surprised just about everyone Thursday when he said that health insurance companies don't have to cancel policies after all—even if they don't meet health reform requirements. But this begs some big questions: Can he pull it off? And, what does it mean for you?

Here's what you need to know about the roll-back of private insurance cancellations and the new state of Obamacare:

First off, can President Obama really do this?

It seems he can. It's not that he's changed anything in the law. It's more a case of saying his government won't enforce it, kind of like what his administration did when it gave employers an extra year to provide health insurance for workers last July.

"Obamacare doesn't directly affect us, but does distract our clients," explains Tom Watjen, Unum Group president & CEO. He says the technical system is "just a piece of the puzzle."

What Obama's decision does do is kick the cancellation decision back to state insurance commissioners and the insurance companies themselves. "It was a blame-shifting exercise," says Dr. Scott Gottleib, a health policy expert at the American Enterprise Institute.

Can I get my policy back if it was canceled?

That's complicated. It's not so easy for an insurance company to reinstate policies it was planning to discontinue, because the firm must plan premiums and budget for expenses far in advance. Florida Blue said it would reinstate canceled plans, and Florida's insurance commissioner, Kevin McCarty, said he's working with any companies that wanted to go that route. A lot is up to state insurance commissioners—something that gives cover to both the White House and to the insurance companies.

Obama said most people won't want to, anyway, and he urged anyone who's had an individual policy canceled to look at what's available at HealthCare.gov before looking to reinstate the old policy.

What if everyone who got canceled decides to ask for their old policies back? Will this mess everything up?

Insurers and actuaries—the people who calculate insurance risk—think it could. "The NAIC (National Association of Insurance Commissioners) has been clear from the beginning that allowing insurers to have different rules for different policies would be detrimental to the overall market and result in higher premiums," says Louisiana's insurance commissioner, Jim Donelon, president of the NAIC.

"This decision continues different rules for different policies and threatens to undermine the new market, and may lead to higher premiums and market disruptions in 2014 and beyond."

And the American Academy of Actuaries said in a letter sent to Congress that the decision could mess up what are called risk pools—basically, the idea that you need healthy people in any group of insurance policies to pay premiums and offset the costs of sick people.

They said people who have lower medical costs would want to stay in bare-bones plans that are being canceled by insurance companies, because they have lower premiums than the new plans that are required to cover more.

But Gottlieb says this isn't necessarily true. He thinks some sick people who use a lot of different providers and therefore want to be able to choose from extensive networks of doctors will be the ones most likely to want to keep their old plans. "The Obamacare plans, they constrain the network," he says. "Most Americans are willing to give up benefits for a wider network."

If there's a mix of sick and well people choosing to reinstate plans, the effects might be negligible.

Will my premiums go up?

Not this year for policies already issued. Rates have already been set for 2014. They could go up in 2015.

So will this decision mess up the whole Affordable Care Act?

Almost certainly not.

Ceci Connolly, managing director of PwC's Health Research Institute, says it's all very confusing but notes that Obama's decision really doesn't affect a large majority of Americans. "We are talking about a small universe of people," she says. Only about 11 million people have policies on the individual market, she says, adding: "They typically turn over. They are not the same 11 million from year to year."

It does mean there will be a few unpleasant weeks for the health-care industry and for government. "Between now and December 15, an awful lot has to happen," she says. "Not only fixing a website but now many more people trying to decipher complicated decisions and insurance companies having to make a decision that is going to impact their business in a very short period of time. I don't know that it's going to be a very happy Thanksgiving for people working on health care."

Oh, yeah, what about that website? Am I ever going to be able to get on?

Remember, if you already have insurance—and 85 percent of Americans do—you don't have to worry about any of this. The HealthCare.Gov website was set up to help people who don't have insurance, either through an employer, Medicare or Medicaid or federal government benefits.

But if you have been waiting to get on, the Health and Human Services Department says keep trying.

And you may have to try more than once, even now, after six weeks of repair work.

"I think it is not possible for me to guarantee that 100 percent of the people 100 percent of the time going on this website will have a perfectly seamless, smooth experience," Obama said this week. "We're going to have to continue to improve it even after November 30th, December 1st. But the majority of people who use it will be able to see it operate the way it was supposed to."

Can't I just call one of the call centers or file a paper application with one of those trained experts?

You can, but your application still has to go through the website at some point, even if you're not the one sitting there pushing the buttons.